The impact of lymph node dissection on survival in patients with clinical early-stage ovarian cancer / 부인종양

Objective@#To estimate the impact of lymph node dissection on survival in patients with apparent early-stage epithelial ovarian cancer (EOC). @*Methods@#We conducted a retrospective review of patients with clinical stage I–II EOC. All patients underwent primary surgery at Sun Yat-sen University Cancer Center between January 2003 and December 2015. Demographic features and clinicopathological information as well as perioperative adverse events were investigated, and survival analyses were performed. @*Results@#A total of 400 ovarian cancer patients were enrolled, and patients were divided into 2 groups: 81 patients did not undergo lymph node resection (group A), and 319 patients underwent lymph node dissection (group B). In group B, the median number of removed nodes per patient was 25 (21 pelvic and 4 para-aortic nodes). In groups A and B, respectively, the 5-year progression-free survival (PFS) rates were 83.3% and 82.1% (p=0.305), and the 5-year overall survival (OS) rates were 93.1% and 90.9% (p=0.645). The recurrence rate in the retroperitoneal lymph nodes was not associated with lymph node dissection (p=0.121).The median operating time was markedly longer in group B than in group A (220 minutes vs. 155 minutes, p<0.001), and group B had a significantly higher incidence of lymph cysts at discharge (32.9% vs. 0.0%, p<0.001). @*Conclusion@#In patients with early-stage ovarian cancer, lymph node dissection was not associated with a gain in OS or PFS and was associated with an increased incidence of perioperative adverse events.

Low initial human papillomavirus viral load may indicate worse prognosis in patients with cervical carcinoma treated with surgery / 부인종양

OBJECTIVE: To evaluate the prognostic implication of human papillomavirus (HPV) viral load in cervical cancer patients who underwent radical hysterectomy. METHODS: We conducted a retrospective review of patients with stage IA2 through stage IIIA cervical carcinoma who underwent radical hysterectomy at Sun Yat-sen University Cancer Center between January 2005 and December 2009. Patients who had undergone preoperative hybrid capture 2 testing to detect HPV DNA were included. A total of 346 patients positive for HPV DNA were enrolled and stratified into two groups according to the median HPV viral load. RESULTS: HPV viral load was significantly correlated with lymphovascular space invasion (p=0.026) and deep stromal invasion (p=0.024). However, other factors, such as age, stage, histologic grade, histologic type, lymph node metastasis, and tumor size, were not significantly associated with viral load. Low HPV viral load was correlated with poor disease-free survival in univariate analysis (p=0.037) and multivariate analysis (p=0.027). There was no significant difference in overall survival with regard to initial HPV viral load. CONCLUSION: Low initial HPV viral load may be a poor prognostic factor for cervical cancer patients who have undergone radical hysterectomy.

Clinical outcome of 31 patients with primary malignant melanoma of the vagina / 부인종양

OBJECTIVE: To investigate the clinical characteristics of and prognostic factors for primary malignant melanoma of the vagina. METHODS: Clinical data from 31 patients treated for primary malignant melanoma of the vagina at the Sun Yat-sen University Cancer Center between March 1970 and June 2005 were retrospectively analyzed. RESULTS: The median age was 58 years (range, 18 to 73 years), and the main symptoms reported were vaginal bleeding and vaginal discharge. Most tumors were of the nodular type and classified as stage I according to International Federation of Gynecology and Obstetrics staging criteria. Surgery was performed on 22 patients, chemotherapy was administered to 7 patients, and immunotherapy was administered to 19 patients. Recurrent tumors developed in 11 patients (35.5%) during a median follow-up period of 20.2 months (range, 1 month to 18 years). The 5-year overall survival rate was 32.3%. Univariate analysis revealed that macroscopic tumor growth and the treatment method significantly affected survival outcome (p=0.039 and p<0.001, respectively), whereas the radicality of surgery did not (p=0.296). Multivariate analysis revealed that macroscopic tumor growth (hazard ratio [HR], 4.1; 95% confidence interval [CI], 1.4 to 12.1; p=0.010) and treatment method (HR, 0.3; 95% CI, 0.1 to 0.9; p=0.025) were independent prognostic factors for overall survival. CONCLUSION: Patients with primary vaginal melanoma have a poor prognosis. Macroscopic tumor growth and treatment method are prognostic factors for primary malignant melanoma of the vagina.

Treatment and prognostic analysis of ovarian cancer patients with isolated region of lymph node recurrence / 中华妇产科杂志

Objective To evaluate the management and survival of lymph node region recurrence of epithelial ovarian cancer (EOC),and discuss its suitable therapeutic strategy.Methods Thirty-eight patients with the recurrence of lymph node region were extracted from 1945 patients who were diagnosed EOC and treated in Sun Yat-sen University Cancer Center from January 1995 to December 2008.The clinical characteristics,therapy methods and survival of them were retrospectively analyzed.Patient age at initial diagnosis was ＞ 50 years old in 24 patients and ≤50 years old in 14 patients.There were 15 cases with stage Ⅱ and 23 cases with stage Ⅲ in terms of initial International Federation of Gynecology and Obstetrics (FIGO,1987) staging.Classified with histological grade,7 cases were in G1,14 cases were in G2,17 cases were in G3 ;according to the histological types,19 cases were with serous adenocarcinomas,and 19 cases were with non-serous adenocarcinomas (including 9 endometrioid adenocarcinoma,1 mucinous adenocarcinoma and 9 unclassified adenocarcinoma).The median follow-up time was 59 months (ranged 16 to 124 months).Results (1) Feature of recurrences:the median interval of last treatment to recurrence was 18 months (range 9 to 96 months).Most of them were absence of symptoms.The serum level of CA125 was elevated in 15 patients(39％,15/38).(2) Treatment of recurrences:of the 38 patients,19 underwent lymphadnectomy for recurrence regions and received adjuvant chemotherapy (surgery + chemotherapy group),14 received local radiotherapy and adjuvant chemotherapy (radiotherapy + chemotherapy group),5 received chemoherapy only (chemotherapy group).There were 35 cases achieved complete response (CR),including 19 patients underwent secondary debulking surgery in surgery + chemotherapy group,14 cases in radiotherapy + chemotherapy group (12 of them treated by radiotherapy,the other 2 cases reached CR after adjuvant chemotherapy) and 2 cases in chemotherapy group.While only 3 patients reached partial response in chemotherapy group.(3) Survival and second recurrences:during follow-up,14 cases died of tumor,4 cases survival with tumor while 20 cases survival without evidence of tumor.The 5-year post-recurrence survival rate of 38 cases was 66.5％,with 71.8％,68.8％ and 40.0％ in surgery +chemotherapy,radiotherapy + chemotherapy,and chemotherapy group,respectively,and there was no significant difference in survival rate between them (P ＞ 0.05).A total of 15 patients experienced second recurrences,including 7 cases with peritoneal and 8 cases with lymph node region recurrences.(4) Prognosis factors:the univariate analysis shown that survival after recurrence was significantly related to patient age,tumor-free interval and number of recurrence disease (P ＜ 0.05),while not to FIGO stage,histological type,histological grade,and lymphadnectomy during primary surgery (P ＞ 0.05).The multivariate analysis showed that patient age and tumor-free interval were independent prognostic variables for survival after recurrence (P ＜ 0.05).Conclusions The lymph node region recurrence of EOC may be have good prognosis and distinctive clinical process.Local treatment strategies including secondary surgery and radiotherapy should be considered,which may significantly improve survival in ovarian cancer patients with lymph node region recurrence.